Endovascular Reperfusion Therapy in Minor Stroke with Neurologic Deterioration beyond 24 Hours from Onset / 신경중재치료의학

Purpose@#Patients with minor stroke (National Institutes of Health Stroke Scale score ≤5) and large vessel occlusion (LVO) often experience neurological deterioration >24 hours after onset. However, the efficacy of endovascular reperfusion therapy in these patients remains unclear. The aim of this study was to determine the efficacy and safety of reperfusion therapy in patients with minor stroke and neurological deterioration >24 hours after onset. @*Materials and Methods@#Data were retrospectively reviewed from patients between January 2019 and April 2022 who met the following criteria: (1) minor stroke and small definitive ischemic lesions at initial visit, (2) onset to neurological deterioration >24 hours, (3) cortical signs, Alberta Stroke Program Early computed tomography (CT) Score >6 points, and large artery occlusion confirmed by CT angiography at neurological deterioration. Efficacy and safety outcomes were based on final thrombolysis in cerebral infarction (TICI), incidence of symptomatic intracranial hemorrhage (ICH), and mortality. Outcomes were assessed using the modified Rankin Scale (mRS) at 3 months. Good outcome was defined as a mRS of 0, 1, or 2. @*Results@#Data from 26 patients (38.4% female, mean age 75.8 years) were analyzed; 18 (69.2%) had a good outcome. A final TICI of 2b or 3 was observed in 24 (92.3%) patients. No other adverse events, including dissection, vasospasm or distal embolization, were observed during the procedures. Hemorrhagic events occurred in 8 patients after the procedure; however, there were no symptomatic ICHs. Good prognostic factors were younger age (P=0.062) and carotid stenting (P=0.025). @*Conclusion@#Endovascular reperfusion therapy performed in selected patients with minor stroke, LVO, and neurological deterioration >24 hours after stroke onset demonstrated favorable outcomes and safety.

Rescue Endovascular Treatment to Prevent Neurological Deterioration in Acute Symptomatic Bilateral Vertebral Artery Occlusion / 신경중재치료의학

Bilateral vertebral artery occlusive disease has been considered as a favorable condition with good collaterals. However, the prognosis of acute ischemic stroke secondary to symptomatic bilateral vertebral artery occlusion (BVAO) and endovascular treatment (EVT) has rarely been reported. We retrospectively selected patients with acute ischemic stroke admitted for symptomatic BVAO between January 2020 and February 2023. All patients with ischemic stroke were evaluated for ischemic lesion and arterial status using brain imaging and angiography. The prognosis of acute stroke with symptomatic BVAO was compared between EVT and conventional treatment. Outcomes were evaluated using modified Rankin Scale (mRS) score at 3 months follow-up. Within the study period, 17 of 2,655 acute ischemic stroke patients were diagnosed with ischemic stroke with symptomatic BVAO. The median age of these patients was 70 (interquartile range 44–89) years, and 13 (76%) were male. Seven patients received emergent EVT with stenting and 10 patients received conventional medical treatment only. Nine of 10 patients with conventional treatment had in-hospital stroke progression and developed new ischemic lesions in the pons and midbrain. Five patients with fetal and hypoplastic posterior communicating artery presented bilateral cerebral peduncular lesions. At 3 months follow-up, 6 patients (35%) had favorable outcomes (mRS 0–2), of which 5 were treated with vertebral artery stenting and 1 received conventional treatment. Ischemic stroke in patients with acute symptomatic BVAO is uncommon. However, stroke progression is common, and the prognosis of most patients is poor. Rescue management such as EVT might be considered for symptomatic BVAO.

Hemorrhagic Lumbar Synovial Cyst after Microscopic Discectomy

Intraspinal synovial cysts are rare but they are being documented with increasing frequency due to improvements in radiological imaging. However, hemorrhage into synovial cysts is uncommon, and affected patients may present with acute onset radiculopathy. This type of hemorrhage is known to result from rupture of fragile neoangiogenic vessels in the cyst wall, due to a traumatic event or anticoagulant therapy. Here, the authors present a rare case of hemorrhagic lumbar synovial cyst caused by spinal instability after microscopic discectomy. To the best of the authors’ knowledge, this is the first report of hemorrhagic lumbar synovial cyst caused by spinal instability following microscopic discectomy in the absence of a traumatic event or anticoagulant therapy. We discuss the pathophysiological mechanism of this uncommon entity and provide a review of the literature.

Adjacent Bilateral Stress Pedicle Fractures after Instrumented Lumbar Fusion: A Case Report / 대한신경손상학회지

Bilateral pedicle stress fractures are rare even in the elderly. Bilateral pedicle fractures are due to post-surgical complications at the level of fusion or stress related activities in most cases. The authors describe a unique case of adjacent L4 bilateral pedicle fractures, which developed 4 years after anterior lumbar interbody fusion with bone cement augmented screw fixation at the L5-S1 level. As far as the authors' knowledge, no similar case has been previously reported in the literature. The pathophysiological mechanism of this rare entity is discussed with review of relevant literature.

Immunomodulatory effect of canine periodontal ligament stem cells on allogenic and xenogenic peripheral blood mononuclear cells

PURPOSE: The aim of this study was to investigate the immunomodulatory effects of canine periodontal ligament stem cells on allogenic and xenogenic immune cells in vitro. METHODS: Mixed cell cultures consisting of canine stem cells (periodontal ligament stem cells and bone marrow stem cells) and allogenic canine/xenogenic human peripheral blood mononuclear cells (PBMCs) were established following the addition of phytohemagglutinin. The proliferation of PBMCs was evaluated using the MTS assay. The cell division of PBMCs was analyzed using the CFSE assay. The apoptosis of PBMCs was assessed using the trypan blue uptake method. RESULTS: Periodontal ligament stem cells and bone marrow stem cells inhibited the proliferation of allogenic and xenogenic PBMCs. Both periodontal ligament stem cells and bone marrow stem cells suppressed the cell division of PBMCs despite the existence of a mitogen. No significant differences in the percentages of apoptotic PBMCs were found among the groups. CONCLUSIONS: Canine periodontal ligament stem cells have an immunomodulatory effect on allogenic and xenogenic PBMCs. This effect is not a product of apoptosis of PBMCs but is caused by the inhibition of cell division of PBMCs.

Roles of heme oxygenase-1 in curcumin-induced growth inhibition in rat smooth muscle cells

In vascular smooth muscle cells (VSMCs), induction of the heme oxygenase-1 (HO-1) confers vascular protection against cellular proliferation mainly via its up-regulation of the cyclin-dependent kinase inhibitor p21(WAF1/CIP1) that is involved in negative regulation of cellular proliferation. In the present study, we investigated whether the phytochemical curcumin and its metabolite tetrahydrocurcumin could induce HO-1 expression and growth inhibition in rat VSMCs and, if so, whether their antiproliferative effect could be mediated via HO-1 expression. At non-toxic concentrations, curcumin possessing two Michael-reaction acceptors induced HO-1 expression by activating antioxidant response element (ARE) through translocation of the nuclear transcription factor E2-related factor-2 (Nrf2) into the nucleus and also inhibited VSMC growth triggered by 5% FBS in a dose-dependent manner. In contrast, tetrahydrocurcumin lacking Michael-reaction acceptor showed no effect on HO-1 expression, ARE activation and VSMC growth inhibition. The antiproliferative effect of curcumin in VSMCs was accompanied by the increased expression of p21(WAF1/CIP1). Inhibition of VSMC growth and expression of p21(WAF1/CIP1) by curcumin were partially, but not completely, abolished when the cells were co- incubated with the HO inhibitor tin protoporphyrin. In human aortic smooth muscle cells (HASMCs), curcumin also inhibited growth triggered by TNF-alpha and increased p21(WAF1/CIP1) expression via HO-1-dependent manner. Our findings suggest that curcumin has an ability to induce HO-1 expression, presumably through Nrf2-dependent ARE activation, in rat VSMCs and HASMCs, and provide evidence that the antiproliferative effect of curcumin is considerably linked to its ability to induce HO-1 expression.

The Clinical Study on the Neonate Delivered Under the Condition of the Maternal Smoking and Alcohol in Pregnancy / 소아과

PURPOSE: Perinatal complications associated with maternal smoking and alcohol ingestion in pregnancy have been well documented. But until now there has been no clinical data on it collected in our country. In this paper, we tried to research the association between maternal smoking and alcohol ingestion in pregnancy and the physical indices of the neonate at delivery among unmaried mothers from one charitable institution. METHODS: We enlisted 125 unmarried with a history of smoking and alcohol consumption during pregnancy who delivered a baby in National Medical Center from March, 2001 to March, 2004 as a study group. As a control, 174 unmarried mothers without a history of smoking and alcohol were enlisted. Then, we compared the physical indices - birth weight, height, and the head circumference - of the neonates from both groups. Furthermore, we investigated the effects of the period and the quantity of maternal smoking and alcohol ingestion on the physical indices of the neonates from the both groups. RESULTS: Low physical indices of neonates were found in the study group(either smoking group, or drinking group) compared with the control group. The quantity of smoking or drinking and the period of smoking or drinking have no significant effect on physical indices. CONCLUSION: We found that maternal smoking and alcohol result in the low physical index of neonates, and educational initiatives must be directed at expectant mothers to emphasize the harmful effects of smoking and alcohol ingestion in pregnancy.

Observation on Causes of Adoption and Social Background of Children in Adoption Institution(5th Report) / 소아과

PURPOSE: Through a review of data provided by an adoption institution, this study was designed to provide a clue to help to reduce the abandonment of children by comparing the conditions at birth, social background, reason for request for adoption, and the degree of dependence on foreign adoption compared with the previous four reports. METHODS: A total of 445 children who had been admitted to an institution during the period of 1997 to 2001 were subjected to the study. Medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1:0.87. The mean birth weight was 2.97+/-0.70 kg, and the mean gestational age was 38.8+/-2.4 weeks. Full term babies accounted for 82%. Most of the children(94.8%) admitted to the studied institution were under one month of age, which showed a significant increase compared to the previous results. Most of the children(98.9%) were delivered at a hospital and this percentage was significantly higher than that of the previous results. The average age of the mothers was 21.2+/-5.7 years. Most of them(52.1%) fell between the ages of 16 and 20, which showed a significant increase as compared to the previous result. Four hundred(89.9%) babies were first bornes, and the majority of adoption requests were made by unmarried mothers (83.6%). The vast majority(96.4%) were adopted in foreign countries. CONCLUSION: The main reason for adoption was the unmarried status of the baby's mothers and the maternal age tended to be younger. In order to reduce the number of unmarried mothers and consequent adoptions, first of all, an overall social view on adoption must change, and active promotion of domestic adoption must be carried out and supported by the country.

Analysis on the Childhood Cancers Based on Cancer Registry Program in Korea in the Recent 5 Years / 대한소아혈액종양학회지

PURPOSE: The purpose of this research is to elucidate the trend of incidence of childhood cancers for the recent 5 years and to use this study as a database of childhood cancers research by comparing to the existing data. METHODS: Childhood cancer patients registered in the cancer registry program of the Ministry of Health and Welfare in Korea during January 1, 1995 to December 31, 1999 were included as study samples. Our current data was obtained to be compared with the previous results 1st report during 1982~1987 and 2nd report during 1988~1992). Analysis of our study was obtained from the data of the patients of childhood cancers under 15 years old registered in the 128 hospitals, except for the patients who are registered repeatedly. RESULTS: Accumulated number of cases of the childhood cancers was 5, 433 (1.5% of the total cases of all ages). A male to female incidence ratio was 1.3 to 1. The most common malignant tumor was leukemia (33.1%). Out of 1, 800 cases of leukemia, 1, 142 cases (63.4%) were lymphoid leukemia, 468 cases (26.0%) were acute non-lymphocytic leukemia and 97 cases (5.4%) were chronic myeloid leukemia. The second most common malignancy was central nervous system tumor (16.0%), followed by lymphoma (8.0%), gonadal and germ cell tumors (7.9%), sympathetic nervous system tumor (6.7%), bone tumor (5.1%), soft tissue sarcoma (4.8%), renal tumor (4.0%), retinoblastoma (3.3%) and hepatic tumor (2.6%). The most common malignant tumor in the 0~4 year-old age was leukemia (32.6%), followed by central nervous system tumor (12.7%) and sympathetic nervous system tumor (11.5%). In the 5~9 year-old age group, the most common malignant tumor was leukemia (38.0%), as well, followed by central nervous system tumor (21.7%) and lymphoma (11.6%). In the 10~14 year-old age group, the most common cancers were leukemia (29.8%), central nervous system tumor (16.5%) and bone tumor (11.7%). CONCLUSION: We were unable to note any differences in the incidence of childhood cancers when comparing the current data and the previous ones.